Laserfiche WebLink
12/1:x/2005 16:13 2094689324 SJCO PERMITS PAGE 02/02 <br /> APPLICATION FOR ENCROACHMENT pTRMIT <br /> PLEA-819 PRIMT: <br /> Date q u e r 2-4) 2cG <br /> OrFlcg USE ONLY <br /> To: San Joaquin County aOh #11 6- _ R3F # <br /> Department of Public Works APN CR # <br /> EXP. DATF <br /> VALID 2�D <br /> LID To t DRIVEWAYS <br /> (Applicant N�as_i/} STREET rl <br /> J��6 �ja'•2 e+t ✓� l Q I AREA QUAD <br /> TYPE he4elAf * �— <br /> (Railing Addretam)^ FORMS <br /> /✓�rt'IcNZ 7J jT'� NOTg <br /> (City, State, zip Code) <br /> 925 �bc - Z 6G <br /> (Area Code _ Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> '5� �J,_v_ f P1*,1 54ze.ts I <br /> 6o4roo4ar skr-[( 44NJ� Acc.W Aynap. <br /> dais prior 4b closute_ as no+--d in <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on side of by performing the <br /> following work (description of work) <br /> Gh ' O of -P/' Yp'CC�l: �t r (�}'0' Cc Uwl <br /> 5 rIRQ -2 �u✓� 1 rirR a a1 i <br /> work will commence on or about fora <br /> 'z 1✓-t4✓'S pprcximately <br /> -- <br /> 1, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to-do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> u4 iature of Applicant Title V pate <br /> Sieve. 6e�ear e pk. <br /> HAs'1'ga.Fe\t?RRSC4mL f6/Oa1 <br />